Comment on “Differential synovial fluid white  blood cell count for the diagnosis of chronic peri-prosthetic joint infection – a systematic review  and meta-analysis” by Sabater-Martos et al. (2025)

van Egmond, Pim W.; van der Jagt, Olav P.; Kuiper, Jesse W. P.

doi:https://doi.org/10.5194/jbji-10-335-2025

Articles | Volume 10, issue 5

https://doi.org/10.5194/jbji-10-335-2025

© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.

https://doi.org/10.5194/jbji-10-335-2025

© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.

Articles | Volume 10, issue 5

Letter

|

05 Sep 2025

Letter |

| 05 Sep 2025

Comment on “Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection – a systematic review and meta-analysis” by Sabater-Martos et al. (2025)

Pim W. van Egmond, Olav P. van der Jagt, and Jesse W. P. Kuiper

Cited articles

Berger, P., Van Cauter, M., Driesen, R., Neyt, J., Cornu, O., and Bellemans, J.: Diagnosis of prosthetic joint infection with alpha-defensin using a lateral flow device: a multicentre study, Bone Joint J., 99-B, 1176–1182, https://doi.org/10.1302/0301-620X.99B9.BJJ-2016-1345.R2, 2017.

Kuiper, J. W. P., Verberne, S. J., van Egmond, P. W., Slot, K., Temmerman, O. P. P., and Vos, C. J.: Are Accuracy Studies for Periprosthetic Joint Infection Diagnosis Inherently Flawed? And What to Do with Schrödinger's Hips? A Prospective Analysis of the Alpha Defensin Lateral-Flow Test in Chronic Painful Hip Arthroplasties, Hip Pelvis, 34, 236–244, https://doi.org/10.5371/hp.2022.34.4.236, 2022.

Lenski, M. and Scherer, M. A.: Synovial IL-6 AS inflammatory marker in periprosthetic joint infections, J. Arthroplast., 29, 1105–1109, https://doi.org/10.1016/j.arth.2014.01.014, 2014.

Sabater-Martos, M., Clauss, M., Ribau, A., Sousa, R., Wouthuyzen-Bakker, M., Bauer, T., Berbari, E., Cortes-Penfield, N., Dietz, M., Esteban, J., Ferry, T., Gehrke, T., Glaudemans, A., Langworth, B., McNally, M., Miller, A., Nelson, S., Parvizi, J., Patel, R., Rohde, H., Seyler, T., Sigmund, I., and Soriano, A.: Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection – a systematic review and meta-analysis, J. Bone Joint Infect., 10, 165–184, https://doi.org/10.5194/jbji-10-165-2025, 2025.

Wang, Y., Li, G., Ji, B., Xu, B., Zhang, X., Maimaitiyiming, A., and Cao, L.: Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis, Bone Joint Res., 12, 559–570, https://doi.org/10.1302/2046-3758.129.BJR-2022-0432.R1, 2023.

Short summary

Many studies evaluating infection tests after joint replacement focus only on patients who have surgery, but not all painful joints are operated on. This can lead to biased results. Our comment highlights this issue and suggests that including patients who do not have surgery but are monitored over time can give a clearer picture. This helps ensure that infection tests are more accurate when used in everyday medical practice, not just in surgical cases.